Page kidney: Rare cause of acute kidney injury after complicated renal artery angioplasty

Abstract The authors present a case of a patient who experienced a rare complication after attempted renal angioplasty and stenting, Page kidney. This patient presented with new onset hypertension secondary to bilateral renal artery stenosis and was referred for revascularization given hypertension refractory to medical management. The right renal artery underwent successful angioplasty and stenting; however, the left renal artery experienced recoil stenosis. Post‐procedure the patient developed acute kidney injury secondary to Page kidney from subcapsular and extracapsular hematoma. This was managed conservatively with transfusions and the hematoma and acute kidney injury self‐resolved over the next 4 months. This case highlights the importance of revascularization for refractory hypertension secondary to hemodynamically significant bilateral renal artery stenosis, the rare complication of Page kidney with attempted revascularization of renal artery stenosis and the involvement of a hypertension specialist in the decision of revascularization of renal artery stenosis

Infolding of fenestrated endovascular stent graft

We report a case of infolding of a fenestrated stent graft involving the visceral vessel segment after a juxtarenal abdominal aorta aneurysm repair. The patient remains free of any significant endoleak, and the aortic sac has shown regression. The patient remains asymptomatic, with no abdominal pain, with normal renal function, and without ischemic limb complications. We hypothesize that significant graft oversizing (20%-30%) with asymmetric engineering of the diameter-reducing ties may have contributed to the infolding. Because of the patient's asymptomatic nature and general medical comorbidities, further intervention was deemed inappropriate as the aneurysmal sac is regressing despite the infolding

Endoluminal dilatation for embedded hemodialysis catheters: A case-control study of factors associated with embedding and clinical outcomes.

BACKGROUND:With the increasing frequency of tunneled hemodialysis catheter use there is a parallel increase in the need for removal and/or exchange. A small but significant minority of catheters become embedded or 'stuck' and cannot be removed by traditional means. Management of embedded catheters involves cutting the catheter, burying the retained fragment with a subsequent increased risk of infections and thrombosis. Endoluminal dilatation may provide a potential safe and effective technique for removing embedded catheters, however, to date, there is a paucity of data. OBJECTIVES:1) To determine factors associated with catheters becoming embedded and 2) to determine outcomes associated with endoluminal dilatation. METHODS:All patients with endoluminal dilatation for embedded catheters at our institution since Jan. 2010 were included. Patients who had an embedded catheter were matched 1:3 with patients with uncomplicated catheter removal. Baseline patient and catheter characteristics were compared. Outcomes included procedural success and procedure-related infection. Logistic regression models were used to determine factors associated with embedded catheters. RESULTS:We matched 15 cases of embedded tunneled catheters with 45 controls. Among patients with embedded catheters, there were no complications with endoluminal dilatation. Factors independently associated with embedded catheters included catheter dwell time (> 2 years) and history of central venous stenosis. CONCLUSION:Embedded catheters can be successfully managed by endoluminal dilatation with minimal complications and factors associated with embedding include dwell times > 2 years and/or with a history of central venous stenosis

Review of literature.

<p>Review of literature.</p

Access characteristics.

<p>Access characteristics.</p

Endoluminal dilatation for embedded hemodialysis catheters: A case-control study of factors associated with embedding and clinical outcomes - Fig 1

<p>Endoluminal Dilation: (A, B and C) An 8 x 80mm balloon is inserted over a guidewire into the venous lumen of an embedded tunneled dialysis catheter and inflated along the length of the catheter from its distal tip to the cuff. Balloon inflation pressure of between 12 (rated burst pressure) and 20atm is used and maintained until there is complete or near complete effacement of areas of narrowing, assumed to represent the principle points of tethering of the catheter to the venous wall. The catheter is then easily removed. (D and E) If performing a catheter exchange, a 0.035inch guidewire is inserted through the arterial lumen of the embedded catheter just before its removal and used for insertion and inflation of a 12 x 40mm balloon along the length of the SVC and brachiocephalic vein. The balloon is then removed followed by insertion of a new tunneled dialysis over the guidewires and through the initial subcutaneous tract.</p

Causes for catheter removal.

<p>Causes for catheter removal.</p

Demographic characteristics.

<p>Demographic characteristics.</p